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Monday, 21 February 2011

Attachment Parenting Series: Breastfeeding

Welcome to our second installment of the Attachment Parenting Series - Breastfeeding! Don't forget to use the Mister Linky at the bottom to share your own breastfeeding information and experiences!

What is it?

Breastfeeding is the act of providing human milk to an infant or young child via the mother's breasts. In the attachment parenting sense, breastfeeding has both a physical and relational component and as such can be extended to a variety of other feeding methods.

How can we encourage it?

Breastfeeding is such a multi-faceted topic. In the name of brevity, I will be focusing on those aspects of breastfeeding that most relate to Attachment Parenting. For a more comprehensive look at breastfeeding and its many benefits and potential difficulties, I encourage you to check out the recommended reading below.

Benefits

During breastfeeding, the hormones oxytocin and prolactin are released. These hormones reduce the stress hormone cortisol and facilitate bonding between the mother and her new child. Oxytocin causes the uterus to contract, thereby assisting in expelling the placenta, controlling postpartum bleeding, and returning the uterus to its normal size. Oxytocin also causes the mother's milk to let down.

In addition to the benefits of these hormones, there are numerous other physical benefits related to breastfeeding. The breastfed baby receives complete nutrition uniquely tailored to him or her. The antibodies in breastmilk protect a child from many illnesses, and breastfed children have stronger immune systems and fewer allergies. Breastfed children experience a reduced risk of asthma, excema, diarrhea, Crohn's disease, respiratory infections, ear infections, childhood diabetes, childhood cancers, heart disease, multiple sclerosis, obesity, pneumonia, Vit A deficiency, future autoimmune disorders and more. They benefit from appropriate jaw, teeth, speech, and overall facial development. They also have increased cognitive and intellectual development as well as better vision.

The breastfeeding mother also experiences numerous physical benefits, including a reduced risk of breast cancer, ovarian cancer, uterine cancer, endometrial cancer, bone disease, arthritis, and more. She also experiences, in many cases, a delayed return of fertility when practicing ecological breastfeeding. There are also the benefits of convenience (always available, completely portable, and no extra supplies needed) and cost (free!) to consider.

Breastfeeding also brings significant relational benefits to the mother/child pair. The mother's body continues to provide nourishment, warmth, comfort and safety, just as it did when the baby was in the womb. A combination of physical proximity and hormones makes breastfeeding an ideal bonding moment. On difficult days, breastfeeding can allow the pair a chance to peacefully reconnect with each other. Breastfeeding will often calm and comfort an upset, hurt, or overwhelmed child, providing them with a quiet moment of solace at their mother's breast.

Breastfeeding is a mother's first foray into learning to read, trust, and respond to her child's cues. This is a central theme throughout Attachment Parenting. The infant, likewise, develops a strong emotional security as he learns to trust that his needs will be quickly and appropriately responded to. The more sensitive a mother becomes to her child's cues, the better the child becomes at giving those cues. This is the beginning of communication and connection between mother and child. As connection grows, the mother/child relationship becomes increasingly natural and instinctive. The resulting mutual trust and sensitivity is the basis of the parent/child relationship and the foundation upon which future discipline will rely. The better the mother knows her child, and the more the child trusts his or her mother, the easier discipline will be as the child grows.

Getting off to the right start

Because of these physical and relational benefits, it is important that a mother and baby have the best start possible with breastfeeding. This begins with education - knowing beforehand the many benefits of breastfeeding as well as the potential difficulties and how to overcome them.

Gentle birth choices increase the odds of a successful breastfeeding relationship. Once the infant is born, it is ideal that he or she have immediate access to the mother's breast. In addition to the physical benefits to the baby and to the breastfeeding relationship as a whole, this bonding opportunity will give the attachment relationship a strong start. Medical interference disrupts this period of strongest bonding instinct and can impair the infant's rooting reflex.

Frequent feedings over the next 2-5 days will provide the infant with nutrient-dense colostrum and will help the mother's milk to come in. To protect the breastfeeding relationship, ensure that no artificial nipples, pacifiers, sugar water or formula are given to the baby. It is important to ensure a good latch right from the beginning. A good lactation consultant or La Leche League leader can assist in troubleshooting any breastfeeding difficulties that arise.

The next few months

Direct breastfeeding is the most natural and beneficial way to feed a baby (alternatives will be discussed below). To protect the breastfeeding relationship, avoid the use of bottles or pacifiers in the early weeks, as this can lead to nipple confusion, flow preference, and lazy suckling. There is no need to use a bottle so that the father can have an opportunity to feed the child; he will have many other opportunities to bond with his new son or daughter in a way that does not threaten the breastfeeding relationship.

Because the frequency and duration of breastfeeding affects the mother's milk supply, the baby should be fed on cue rather than on a predetermined schedule and should be allowed to suckle for as long as he or she desires. This will ensure that the mother's milk supply is well established in the early weeks and that extra milk is produced during growth spurts. Put aside any notion that feeding on cue will result in a spoiled child. A child whose needs are met now will grow to become emotionally secure, empathetic, and independent, while a child who is pushed into early independence is likely to become needy and clingy instead.

Recognize the signs of hunger - rooting, sticking out tongue, opening and closing mouth, sucking on fist - and offer the breast before before the baby cries. Crying is a very late sign of hunger. Waiting until the baby reaches that stage before breastfeeding him will result in a tired, upset baby who is likely to nurse poorly and fall asleep before receiving a full feeding.

It is, however, to be expected that a baby will fall asleep after a feeding. During breastfeeding, both mother and child release hormones that help them sleep. These hormones, combined with a full stomach and the comfort of his mother's closeness, make it natural for a baby to sleep after eating. This is contrary to much of the popular advice given by "parenting experts", such as the "Eat - Wake - Sleep" cycle laid out by Gary Ezzo in his book Babywise, or the similar EASY cycle - "Eat - Activity - Sleep - You" - recommended by Tracy Hogg in her book The Baby Whisperer. (More about baby trainers later on in the Attachment Parenting Series.) Such a cycle is entirely counter-intuitive and works against the natural sleep-inducing properties of breastfeeding.

The first days or weeks may be painful. Determine ahead of time to work through those early difficulties; a goal of six weeks should get you over the hump and into the far easier and more natural months ahead. Your local La Leche League chapter can be an invaluable support for you during this time. Breastfeeding is not always enjoyable. Sometimes it's painful, sometimes it's boring, and sometimes it's downright annoying. Persevere! Be committed to breastfeeding for all the good it can do for you and your child. This is one of a mother's first opportunities to choose the best for her child even when it is inconvenient to her.

Don't be afraid to nurse your baby wherever you need to. There is no need to hide at home, in the car, or in a back room while breastfeeding. The reason breastfeeding makes people uncomfortable is because they don’t see it enough! Use a blanket if it makes you feel more comfortable, but be aware that doing so is likely to bring more attention to what you are doing. Being confident and matter-of-fact about breastfeeding your baby in public will go a long way in deterring any negative comments.

During the first six months, the baby should be fed exclusively with breastmilk. After six months, solids may be introduced if the child is showing signs of readiness. There is no rush, however, as a delayed introduction of solids has many benefits. As with breastfeeding, know your individual child and follow their cues to know when and how much solids to offer. A baby-led self-feeding approach is ideal. Solids should be considered part of a child's play and experimentation at this age, with breastmilk being the primary source of nutrition throughout the baby's first year.

Extended breastfeeding

Over time, breastfeeding becomes less about nutrition and more about meeting a young child's emotional needs. There is no need to wean a child once they hit the one year mark. Extended breastfeeding (breastfeeding beyond one year) provides numerous physical, emotional, and relational benefits.

The World Health Organization recommends breastfeeding for at least the first two years of life. The American Academy of Pediatrics recommends breastfeeding for at least the first one year of life, and states that "there is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer." The American Academy of Family Physicians notes that children weaned before two years of age are at an increased risk of illness. The average age of weaning worldwide is four years.

Breastfeeding is a loving way to meet the needs of toddlers and young children. It provides respite when overwhelmed, comfort when frustrated or hurt, nutrition when sick, and reconnection for the young child who is now beginning greater exploration of his world apart from his mother. The closeness and availability of the mother through breastfeeding provides security and reassurance, allowing them to grow and mature emotionally. Extended breastfeeding provides a gradual transition from babyhood into childhood.

It is important for the sake of the breastfeeding relationship that nursing manners be introduced and gently enforced early on. Babies can be redirected to a nursing necklace or small toy to discourage excessive twiddling, pinching, or scratching. Toddlers should be expected to ask politely to nurse, using either a word or a sign. Older toddlers may be redirected to a snack or activity, as the need may be, if the mother is unable or unwilling to nurse at that moment.

Gentle weaning

It is extremely rare for a child to self-wean before one year of age. A temporary nursing strike may occur as the older baby becomes more aware of and distracted by his environment. This lack of interest in nursing should not be misinterpreted as weaning. Continue to offer the breast, preferably in a quiet location, and in time the child's interest will return and breastfeeding can resume as normal, with all its many benefits.

Weaning will happen eventually, however. For the Attachment Parent, this may happen in one of two ways:

Child-led weaning: This occurs when the child self-weans, typically between the ages of two and four, because he or she no longer needs to breastfeed either nutritionally or emotionally.

Gradual weaning: This occurs when the mother initiates the weaning process before the child is fully ready.

While child-led weaning is the ideal, many mothers choose to initiate the weaning process for a variety of reasons. Gradual weaning should be a slow, flexible and gentle process. The particular approach will vary depending on the individual needs and desires of the mother and child.

Partial weaning is a good first step for the mother who finds herself needing to cut back on breastfeeding. This may involve night weaning, cutting out most (or all) day feeding, transitioning to a new method of helping the child fall asleep, nursing only at set times of the day, or any other combination that allows the mother to feel able and willing to otherwise continue breastfeeding her child. Because the breastfeeding relationship as a whole will be able to carry on, the child will receive its continued nutritional and emotional benefits.

A sudden "cold-turkey" approach to weaning is almost never recommended due to the distress it will cause both to the child (emotionally) and to the mother (engorgement, clogged milk ducts, and drastic hormone changes).

What if it doesn't happen?

There are times when breastfeeding does not happen. Sometimes this is due to medical issues or insurmountable breastfeeding difficulties. Other times, the mother makes a deliberate decision not to breastfeed, for any number of reasons. Fortunately, many of the attachment-related benefits of breastfeeding can be maintained while using alternative feeding methods.

Supplemental nursing system

A supplemental nursing system (SNS) is a device that allows the infant to suckle at the breast while also receiving supplementation (either pumped breastmilk or formula) through a tube attached to the nipple. This provides many of the same benefits of breastfeeding and can encourage a mother's low milk supply to increase in hopes of eventually transitioning to full-time breastfeeding without the SNS.

Bottle-nursing

If the intent is that supplementation will be temporary, with full-time breastfeeding being the ultimate goal, consider using one of the many bottle alternatives. However, if bottle-feeding is a necessity, it can be done so in a way that supports breastfeeding (when used in conjunction with breastfeeding, such as for the working mother) or mimics breastfeeding (so as to ensure the baby's cues are being followed and the infant is consuming the ideal amount of food). These steps are outlined here.

Breastmilk alternatives

While breastmilk directly from the breast is the ideal, pumped breastmilk from the mother should be the second choice. Donated milk from a milk bank should be explored third, with formula being the next alternative in line.

Skin-to-skin contact

An exclusively breastfed baby receives skin-to-skin contact with each feeding. In the absence of breastfeeding, skin-to-skin contact should be encouraged as much as possible.

Our experiences

My nursing relationship with my older son was an ever-evolving one. It began smoothly, with him latching on as soon as he was placed on my chest, and yet was not without pain - I had my husband running for the hospital gift store to pick up a tube of lanolin by the end of the first day. As the days went on, the pain lessened and I was able to relax into a each quiet session of nursing and bonding.

The next 18 months were filled with highs and lows - the joys of nursing a silly baby combined with the frustrations of wet shirts and long nights. At 18 months, desiring a second child and frustrated by a continued breastfeeding-induced lack of fertility, I began to place limits on his feedings for fear that resentment would adversely affect our breastfeeding relationship.

Shortly before his second birthday, we found we were expecting our second child. I continued to breastfeed, grateful for each week that my milk supply remained unaffected. As my sensitivity to nursing grew along with my stomach, I nightweaned him, which he accepted with relative ease. In this way, he went from three nursing sessions a day plus nightwakings, to only one nursing session at bedtime. He was a little over two years old at this point.

Eventually my milk supply disappeared and the pain while nursing increased. I began to shorten the length of time for which I would nurse him at bedtime, replacing that nighttime routine with other methods of comfort. By the time he was two and a half, he nursed for only a minute or less at bedtime. Then it was mere seconds. Then it was less than a second - not even a real latch on. I joked to my husband that he was just "kissing them goodnight" by that point. One night, instead of wanting milk, he asked to lay on them, leaning against my bare chest for a short while before climbing in bed. Then...nothing. He was truly and officially weaned.

Our second son was born soon after. He, too, had a smooth start to breastfeeding, and I enjoyed the lack of pain this second time around.

With my younger son, I find I have a less romantic and more practical view of breastfeeding. He needs to be fed, and I've got just the tools for the job. And yet on difficult days, when my nursling and I find ourselves feeding off each other's grumpiness, nursing allows us to take a break and quietly snuggle and reconnect, walking away a few minutes later in much better spirits. We've recently passed the one year mark and are now fully entrenched in the typical early-toddler stage of increased nursing. I expect that his eventual weaning will be much the same as his older brother's, with partial weaning initiated by me and ultimate weaning left up to him.

Summary

Breastfeeding is the most normative way of feeding a baby. It has numerous physical, emotional, and relational benefits for both the mother and child. It is a mother's first foray into learning to read, trust, and respond to her child's cues. As the mother and child learn to communicate through the giving and receiving of these cues, a strong connection grows between them. This connection and its resulting mutual trust and sensitivity will form the basis of the parent/child relationship and become the foundation upon which future discipline will rely.

It is important that the breastfeeding relationship get off to a good start. This can be accomplished through education, preparation, gentle birth choices, immediate postpartum bonding, and frequent nursing sessions. The baby should be fed on cue to ensure the mother builds a sufficient and well-established milk supply. Persevering through any early breastfeeding pain and difficulties will more often than not be rewarded with a long and satisfying breastfeeding relationship. Breastmilk should be the primary source of nutrition throughout the baby's first year, with any introduction of solids being considered play and exploration for the child. For the sake of the breastfeeding relationship, nursing manners should not be ignored.

Extended breastfeeding provides a growing toddler and young child with security and reassurance, allowing the child to grow into an emotionally secure, empathetic, and independent individual. While a child-led approach to weaning is ideal, many mothers choose to initiate weaning before the child is fully ready. This mother-led weaning should be gradual, gentle, and flexible. A good beginning may be partial weaning, in which some feedings are eliminated in order to allow the breastfeeding relationship as a whole to continue.

When direct breastfeeding is not an option, alternative feeding methods can be explored which support the attachment-related benefits of breastfeeding. These methods will depend on the particular circumstances, but may include the use of bottle alternatives, breastmilk alternatives, and/or bottle-nursing. Skin-to-skin contact is important in all cases. Regardless of the feeding method chosen, a mother must become adept at reading, trusting, and responding to her child's cues.

Now it's your turn! Add your link using the Mister Linky below to share your thoughts, experiences, resources, or struggles as they relate to breastfeeding. I look forward to reading them! See you next Monday for our third installment - Babywearing!

5 comments:

Great article, Cynthia! The story of how your first boy weaned is very sweet. I think the finding the balance between the child's needs and the mom's needs is a very delicate one, especially when it comes to nursing through pregnancy, and it sounds like you found something that worked for you both.

I linked up an older post this week - a review I wrote about Kellymom a few months ago but that's still relevant for today's topic.

This is a great entry and so well written. I am getting so excited to start this process with my little one in a few months. I'm actually on the breastfeeding section (about 100pgs) in the Baby Book by Dr. Sears.

I wonder, if you don't use a cover in public do you have recommendations for staying mostly covered as to not expose yourself? I know some people really like nursing tops or wear tank tops underneath their regular shirt.

Michelle, it is a delicate balance. Thanks for sharing your Kellymom review!

Momma Jorje, thanks for the feedback!

Korey, great question. I don't tend to worry too much about it, as my shirts keep me covered enough for my comfort. A basic t-shirt with a nursing bra underneath and an open sweater (zippered or buttoned) over top keeps me covered from the top and sides, and the baby covers my stomach. As I wrote about before, I've become a big fan of Getti's Accessories' t-lets for nursing. When paired with a buttoned or low-cut tank, t-shirt, or sweater, they make a perfect nursing shirt. Unbutton/pull down the shirt, pull up the t-let, and there you go - easy access with full coverage. The only actual "nursing shirt" brand that I like is Boob brand - very functional, nice looking, and great coverage - but the price is so much higher than just wearing a regular shirt with either a nursing bra or one of those t-lets.

If I do feel uncomfortable for whatever reason, I put a bunched-up blanket on top of the baby's body. That gives me enough extra coverage without having to drape a blanket right over his head.

Nursing in a baby carrier is another great way of staying completely covered. When I nurse in a wrap, I often have people come up and touch his head without even realizing I'm nursing at all. It has a bit of a learning curve, but I found it worth it.

I've just joined the world of tandem nursing and I've been reading La Leche League's Adventures in Tandem Nursing by Hilary Flower. It's been so helpful in validating my feelings since I know so few women in my position.